The narrative by Hurst1 ends happily: Irene, described in Hurst’s case study, agrees to compromise and stays in the hospital because of the patience and understanding of her caregivers. However much we clinicians remind ourselves to practice patience and understanding, it is worthwhile to have these cardinal values reinforced.
It is less clear to me what the caregivers should have done in the ethically challenging, unhappy case Irene continues to refuse treatment and discussion. In one scenario, which I believe Hurst endorses, “they [the clinicians] should choose a course of action as if the patient were incompetent.” I assume that means that Irene is kept in the hospital against her stated will. In the alternative scenario, Irene hobbles out with active cellulitis and an uncontrolled blood glucose level.
Arnold Blank. Respecting the Autonomy of Irrational Patients. Arch Intern Med. 2005;165(5):590. doi:10.1001/archinte.165.5.590